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PubMedDate not supplied

[Hydro-electrolyte changes induced by transurethral prostatic resection].

Transurethral resection prostatectomy (TURP) has been associated with severe hyponatremia due to massive absorption of bladder irrigation fluid (IF). TURP was performed in 41 patients using Sorbitol-Mannitol IF (Group A) and in 6 patients using distilled water (Group B). Six other patients were operated upon using surgical procedures identical in time and type of anesthesia to TURP (Group C). The three groups were studied with the same protocol that included blood collected before (time I), immediately after (time II) the procedure and 1 hour later (time III). Serum sodium decreased significantly in the 3 groups from time I to time II, an average of 3.4 mEq/l with Mannitol-Sorbitol, 2.3 mEq/l with distilled water, and 4.4 mEq/l in group C. Osmolality did not change significantly between the 3 times of collection and Osmolar Gap only increased from time I to II in the Sorbitol-Mannitol group. In conclusion, mild decrements in serum sodium with no clinical relevance are a common post-TURP finding, but should not be greater than in other similar general surgery without bladder irrigation. Hyposmolality did not constitute a problem.

Aged↗

PubMed1984

Acid phosphatase elevation with symptoms following transurethral prostatic resection.

Symptoms following transurethral prostatic resection for benign prostatic hypertrophy were evaluated in 100 patients. The occurrence of post-transurethral resection symptoms was monitored postoperatively and was found to be associated with an increase in serum acid phosphatase. The transient elevation of serum acid phosphatase after transurethral prostatic resection indicates that intraoperative absorption of prostatic tissue substances occurs. The intraoperative absorption of prostatic tissue substances may have a significant role in producing symptoms of post-transurethral resection syndromes.

Acid Phosphatase↗

PubMed1998

Effects of transurethral prostate resection and transurethral laser prostatectomy on plasma hormone levels.

OBJECTIVE: The short and long-term effects of two common transurethral procedures (TURP and TULP, transurethral prostatic resection and laser prostatectomy, respectively) on plasma hormone levels in patients with benign prostatic hyperplasia (BPH) have been evaluated. PATIENTS AND METHODS: Totally 57 patients with histologically proven BPH (age range 54-81 years, mean 62.5 years) were included into the study program. Of these 57 patients, 44 underwent TURP and 13 underwent TULP for treatment of their bladder outlet obstructions. 20 patients with bladder cancer undergoing transurethral resection (n = 15) and those undergoing transurethral laser ablation (n = 5) constituted the control group. Plasma luteinizing hormone (LH), prolactin (PRL), follicle-stimulating hormone (FSH), adrenocorticotrophic hormone (ACTH), cortisol, aldosterone, dihydroepiandrosterone sulfate (DHEA-S) and testosterone levels were assessed in all patients before and after 3 weeks and 3 months following the aforementioned procedures. Comparative evaluation of the results with respect to the effect of different procedures have been made between study and control groups. RESULTS: Preoperatively, we were not able to demonstrate any significant difference with respect to all but plasma prolactin levels (p < 0.05) between the study and control groups. Prolactin levels were found to be significantly higher in BPH patients. In BPH patients undergoing TURP, while LH levels were significantly higher during the 3 weeks' evaluation (p < 0.001) no significant difference could be shown during the 3 months' examination (p > 0.05). Again, prolactin levels did significantly decline (p < 0.05) in patients undergoing TURP during the 3 weeks' follow-up evaluation, no difference was present 3 months postprocedure. On the other hand, in patients undergoing TULP, while we were not able to show any significant difference with respect to plasma prolactin levels (p > 0.05) pre- and postoperatively, plasma LH levels were significantly increased during the 3-month evaluation (p < 0.05). CONCLUSIONS: Alterations in the plasma levels of LH and prolactin following prostatectomy during follow-up evaluation, led the physicians to consider possible effects of some factors released from resected prostate gland. Behavior of prolactin and LH after TURP and laser ablation is quite different in our study. It may be related to the higher amount of residual prostate tissue after TULP. On the other hand, normalization of hormone levels 3 months following TURP, led us to think about the activation of some factors responsible for hormonal regulation which in turn institutes a new hormonal balance.

Adrenocorticotropic Hormone↗

PubMed1999

Sexual function following high energy microwave thermotherapy: results of a randomized controlled study comparing transurethral microwave thermotherapy to transurethral prostatic resection.

PURPOSE: We evaluate changes in sexual function in patients treated with high energy transurethral microwave thermotherapy compared to transurethral resection of the prostate. MATERIALS AND METHODS: A total of 147 patients randomized to undergo transurethral microwave thermotherapy or transurethral resection of the prostate were asked to complete a self-administered questionnaire evaluating sexual function before, and 3 and 12 months after treatment. The questionnaire dealt with such items as social status, libido, quality of erection, ejaculation and overall satisfaction of sexual functioning. RESULTS: There was a statistically significant improvement of micturition in both groups. The improvement in the transurethral prostatic resection group was significantly better than in the transurethral microwave thermotherapy group. Antegrade ejaculation occurred at 3 months following treatment in 27% of the transurethral prostatic resection group compared to 74% of the transurethral microwave thermotherapy group and at 1 year in 37 and 67%, respectively. Significantly more patients undergoing transurethral prostatic resection (36%) had changes in sexual function compared to the transurethral microwave thermotherapy group (17%). The transurethral microwave thermotherapy group was more satisfied with the sex life. Of these patients 55% graded sex as very satisfying compared to 21% in the transurethral prostatic resection group. The severity of symptoms was not correlated with sexual function in this study. In general, older patients had sexual dysfunction more often, while younger patients had pain during sexual activities more frequently. CONCLUSIONS: Although clinically less effective, high energy transurethral microwave thermotherapy is a better therapeutic option than surgery for patients who want to preserve sexual function. In particular ejaculation is often preserved after transurethral microwave thermotherapy while there is significant deterioration following transurethral prostatic resection. In general, older patients have greater sexual dysfunction.

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PubMed2001

Transurethral prostatic resection or laser therapy for men with acute urinary retention: the ClasP randomized trial.

PURPOSE: Transurethral resection of the prostate is the standard operation for acute urinary retention, although laser prostatectomy is reportedly effective and safe. The ClasP (conservative management, laser, transurethral resection of the prostate) study compared transurethral prostatic resection and noncontact neodymium (Nd):YAG visual laser assisted prostatectomy for treatment of acute urinary retention. MATERIALS AND METHODS: This study was a multicenter randomized controlled trial, analyses were by intention to treat and followup was at 7.5 months after randomization. Primary outcomes were treatment failure, and included International Prostate Symptom Score, International Prostate Symptom Score quality of life score, residual urine and flow rate. Secondary outcomes included complications, and duration of catheterization and hospitalization. RESULTS: A total of 148 men were randomized to transurethral prostatic resection (74) and laser (74). There were fewer treatment failures after prostatic resection (p = 0.008) and fewer men after resection required secondary surgery for poor results (1 versus 7, p = 0.029). Maximum flow rates after transurethral prostatic resection were better than after laser (mean difference 4.4 ml. per second). Comparison of symptom and quality of life scores demonstrated that any clinically significant advantage for laser could be ruled out. Patients stayed a mean of 2 extra days in the hospital after resection. The duration of catheterization was greater after laser but significantly fewer major treatment complications were found with laser therapy. CONCLUSIONS: Transurethral prostatic resection was more effective, resulted in fewer failures than laser treatment and remains the procedure of choice for men with acute urinary retention.

Acute Disease↗

PubMed1999

A computer generated interactive transurethral prostatic resection simulator.

PURPOSE: We developed a computer generated model of the prostate gland and an interactive simulator for use in training urologists in transurethral resection of the prostate. MATERIALS AND METHODS: Software was developed on a standard personal computer which allowed images of the lumen of the prostatic urethra and resectoscope loop to be generated and interacted with using a magnetic position sensor input device attached to a dummy resectoscope. RESULTS: An anatomically accurate computer model of the prostate was generated at low cost which permitted user interaction and which simulated key elements of transurethral prostatic resection. CONCLUSIONS: Although not a substitute for learning transurethral prostatic resection on patients, the simulator enabled the user to become familiar with the technique of transurethral prostatic resection in the absence of time constraints and without risk to patients. The simulator may become an important tool in training and assessing surgeon competency, and may reduce the costs of training. Further development is needed to refine the transurethral prostatic resection simulator and expand its surgical range.

Computer Simulation↗

PubMed2000

[Experiences with routine monitoring of ethanol concentration in expired air in transurethral prostate resection].

During transurethral resection of the prostate (TURP), systemic influx of hypotonic irrigating fluid is a life-threatening event. Its occurrence can lead to TUR syndrome. Addition of ethyl alcohol to the irrigating fluid and analysis of alcohol concentration in the expiratory breath constitute a simple but sensitive monitoring technique for early detection of an influx event and its extent. Clinical experience with this method in 50 patients who underwent TURP is reported. The following parameters were determined: heart beats per minute (heart rate), mean arterial pressure, sodium concentration in the serum, duration of resection, and weight of resected tissue. At 10-min intervals, the alcoholic concentration of the expiratory breath of each patient was measured with the AlcoMed 3011 analyzer (Biotest, Dreieich, Germany). Active measurement was possible in 40 patients, and a passive analytic procedure was used in 5 other patients in whom general anaesthesia was induced. In the remaining 5 patients, the monitoring could not be performed because of a medical history of significant alcohol abuse. A suprapubic trokar was used to decrease intravesical pressure in 16 patients. In 8 of 45 patients, alcohol concentration was > 0.2@1000. Three of them developed TUR syndrome. With regard to the frequency of an influx event, there was no significant difference between resections using a trokar and those performed without a trokar. In addition, there was no correlation between this frequency and the duration of resection or the weight of resected tissue. In single cases, influx of considerable fluid volume was found, whereas in 28 patients, duration of resection was far longer than 60 minutes with no signs of an influx event. Mean arterial pressure and heart rate were not altered in 47 patients during the course of the surgical procedure; however, a decrease in these parameters was observed in the 3 patients who developed TUR syndrome. In each of the 8 patients with increased alcohol concentrations, a significant decrease in the serum sodium concentration was observed. There was no change in sodium concentration during the postoperative course in the remaining 42 patients. The data indicate that monitoring of the alcohol load in the expiratory breath is a simple, non-invasive, reliable and cost-efficient way of detecting an influx of fluids during TURP and allows the anaesthetist to take early steps to prevent the development of TUR syndrome.

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PubMed1984

Pivmecillinam plus pivampicillin versus co-trimoxazole in patients undergoing transurethral prostate resection.

Patients undergoing transurethral prostate resection received a 10-day or a 20-day treatment with a combination of pivmecillinam/pivampicillin or with co-trimoxazole starting 1 day before surgery. The results were evaluated in 139 patients. Fifty-three patients had bacteriuria prior to the operation, and the bacteriological cure rate was 22 out of 25 on pivmecillinam/pivampicillin and 22 out of 28 on co-trimoxazole. Eighty-six patients had no bacteriuria pre-operatively and received treatment prophylactically. Two out of 40 patients on co-trimoxazole developed urosepsis, while pivmecillinam/pivampicillin was effective in preventing septicaemic episodes in all 46 patients treated. Tolerance was good with mild side-effects in 5 patients on pivmecillinam/pivampicillin and in 2 patients on co-trimoxazole.

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PubMed2001

Urodynamic pressure flow studies can predict the clinical outcome after transurethral prostatic resection.

PURPOSE: We evaluate whether urodynamic evaluation can determine preoperatively the clinical prognosis of patients treated with transurethral prostatic resection as measured by urinary symptom score and quality of life index. MATERIALS AND METHODS: A total of 253 patients who previously elected transurethral prostatic resection based on clinical symptoms completed the American Urological Association symptom score and quality of life index, and underwent urodynamic evaluation before and after operation. The patients were divided into 7 groups in accordance with detrusor pressure at maximum urinary flow rate. The preoperative and postoperative symptom score and quality of life index were analyzed in each group. RESULTS: Of the patients 42% were not obstructed and could not be distinguished from those who were obstructed preoperatively based on total urinary symptoms (p = 0.95) or subjective impression measured by the quality of life index (p = 0.96). The entire obstructed group demonstrated marked improvement compared to the nonobstructed group (p = 0.018). Analysis of severity also revealed a clear relationship with clinical outcome and subjective satisfaction with obstruction grade, that is the more severely obstructed cases had greater clinical benefit compared to those with little or no obstruction. Furthermore, the nonobstructed subjects did not show any clinical or subjective improvement after transurethral prostatic resection (p = 0.24). CONCLUSIONS: Urodynamic studies provide great predictive value of clinical improvement after prostatic relief but they also properly predict the poor clinical results in nonobstructed patients.

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PubMed1998

Catheter-free same day surgery transurethral resection of the prostate.

PURPOSE: Transurethral resection of the prostate using electrocautery has long been the standard method of management of lower urinary tract obstructive symptoms. While there has been a trend towards reduced catheterization time following transurethral prostatic resection, this study outlines the methods and results of transurethral prostatic resection performed in the day surgery setting. MATERIALS AND METHODS: The study was performed at a free-standing licensed day surgical hospital serving a patient population of more than 150,000. A total of 58 patients of a mean age of 68.77 years (range 49 to 87) underwent same day conventional transurethral prostatic resection. Of the procedures 39 (67%) were performed with spinal and the remainder with general anesthesia. RESULTS: Mean overall duration of catheterization was 6.54 hours. Of the 48 patients (82.76%) undergoing single catheterization mean duration was 5.59 hours. Mean total duration of catheterization for 10 patients (17.24%) who required reinsertion of a catheter was 11.09 hours. Duration of catheterization was 7.69 hours for patients treated with spinal and 3.86 for those treated with general anesthesia. Repeat catheterization was required in 10 patients and was due to urethral discomfort in initiating micturition in 8. Postoperative urinary tract infections occurred in 2 patients. No patient was readmitted to the hospital for retention of urine but 1 was admitted to a private hospital for management of postoperative fever and 1 for monitoring of tachycardia. CONCLUSIONS: Conventional transurethral resection of the prostate can be effectively managed in the day surgery setting with minimal morbidity. There are significant advantages in reduction of catheterization time and duration of hospital stay, and the procedure compares favorably with new modalities.

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PubMed2002

Transurethral prostate resection, noncontact laser therapy or conservative management in men with symptoms of benign prostatic enlargement? An economic evaluation.

PURPOSE: We evaluated the cost-effectiveness of noncontact laser therapy compared with transurethral prostate resection and conservative treatment in men with symptoms associated with benign prostatic enlargement. MATERIALS AND METHODS: A total of 340 men with uncomplicated lower urinary tract symptoms participated in a large multicenter pragmatic randomized trial called the CLasP (Conservative management, Laser therapy, transurethral resection of the Prostate) study. Costs to the United Kingdom National Health Service and patients were determined from the time of randomization to the 7.5-month followup. Incremental cost-effectiveness ratios using conservative management as the base case were calculated for certain trial outcomes, including International Prostate Symptom Score (I-PSS), I-PSS quality of life score, maximum urinary flow, post-void residual urine volume, quality adjusted life-years and a composite measure of success based on I-PSS and maximum urinary flow. One-way sensitivity analysis of the basic costs and incremental cost-effectiveness ratios were done from the NHS viewpoint. RESULTS: Mean costs per patient were greatest for noncontact laser therapy and least for conservative management. The incremental cost-effectiveness ratios showed that transurethral prostate resection was more cost-effective than noncontact laser treatment for all primary trial outcomes. The incremental cost-effectiveness ratios of transurethral prostate resection compared with conservative management were pound 81 per unit decrease in the I-PSS score and pound 1,338 per additional successful case per 100 patients. Sensitivity analysis showed that the initial results were robust. CONCLUSIONS: Noncontact laser was the mostly costly treatment option. Transurethral prostate resection was more cost-effective than noncontact laser therapy in terms of symptomatic improvement. In men wishing to delay treatment conservative treatment appears to provide a cost-effective alternative in the short term.

Adult↗

PubMed2001

Long-term followup of randomized transurethral microwave thermotherapy versus transurethral prostatic resection study.

PURPOSE: We evaluate the durable effect of high-energy transurethral microwave thermotherapy and transurethral prostatic resection for treatment of patients with lower urinary tract symptoms suggestive of bladder outflow obstruction. MATERIALS AND METHODS: Between January 1996 and March 1997, 155 patients with lower urinary tract symptoms suggestive of bladder outflow obstruction were randomized to receive transurethral microwave thermotherapy (Prostatron*; device and commercial software) (82) or undergo transurethral prostatic resection (73). Initial patient evaluation was performed according to international standards. Patients were followed annually with the International Prostate Symptom Score (I-PSS) and uroflowmetry (maximum flow rate). The Kaplan-Meier survival analysis was used to calculate the cumulative risk of re-treatment, adjusted for loss to followup. RESULTS: A total of 78 patients received transurethral microwave thermotherapy and 66 underwent transurethral prostatic resection. Median followup was 33 months. In the thermotherapy group mean maximum urinary flow rate improved from 9.2 ml. per second at baseline to 15.1, 14.5 and 11.9 ml. per second at 1, 2 and 3 years, and mean I-PSS decreased from 20 to 8, 9, and 12, respectively. In the resection group the corresponding numbers for maximum urinary flow rate were 7.8, 24.5, 23.0 and 24.7 ml. per second at 1, 2 and 3 years, and for I-PSS were 20, 3, 4 and 3, respectively. At 36 months, 14 patients in the thermotherapy and 8 from the resection groups underwent re-treatment, and the cumulative risk was 19.8% (95% confidence interval 10.4% to 29.3%) and 12.9% (4.5% to 21.3%), respectively (p = 0.28). CONCLUSIONS: Transurethral microwave thermotherapy and transurethral prostatic resection achieve durable improvement in patients with lower urinary tract symptoms suggestive of bladder outflow obstruction, while the magnitude of improvement is higher with resection. The repeat thermotherapy is based on failure of therapy whereas repeat resection is based on complications of therapy.

Aged↗

PubMedDate not supplied

Isotonic hyponatremia following transurethral prostate resection.

The proper treatment of hyponatremia during transurethral resection of the prostate continues to be controversial. Two cases of isotonic hyponatremia are reported here, and the literature regarding the incidence and treatment of hyponatremia during transurethral resection of the prostate is reviewed. In each case, the patient developed neurologic changes during complicated transurethral prostate resection. Despite the rapid decrease in the serum sodium concentration, serum osmolality remained normal due to the resorption of the bladder irrigant glycine. Therefore, etiologies other than cerebral edema are postulated as the cause of the neurologic manifestations. Also, the role of the osmolar gap in directing appropriate therapy is emphasized in an effort to avoid unnecessary use of hypertonic saline. Finally, an appropriate differential diagnosis of the neurologic changes seen during the transurethral resection of the prostate syndrome is discussed.

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PubMed1995

[Long-term results of transurethral prostate incision (TUIP) and transurethral prostate resection (TURP). A prospective randomized study].

TUIP (transurethral incision of the prostate) or TURP (transurethral resection of the prostate) was performed in 120 patients to treat small-volume (< 20 g) benign prostatic hyperplasia in a prospective randomized study. The mean follow up was 43 months. Preoperatively and at regular follow-up visits obstructive and irritative symptom scores were obtained, sexual function was evaluated, and a uroflow study was performed. Both treatments achieved a marked improvement of symptoms. The obstructive, irritative and the total symptom scores did not differ significantly between TURP and TUIP. After 2-3 years the scores slowly increased in both groups. Subjective satisfaction rates averaged about 60% after more than 3 years and remained at this level. Initial significant differences in the peak flow rate in favour of TURP were no longer seen after more than 2 years. In smaller prostates TURP and TUIP are equally effective and since TUIP has fewer side effects and entails lower costs it appears to be an acceptable alternative to TURP.

Adult↗

PubMed2001

Smoking increases the risk of large scale fluid absorption during transurethral prostatic resection.

PURPOSE: We studied the association between smoking habits and absorption during transurethral prostatic resection in healthy patients, and in those with medical disease and prostate cancer. MATERIALS AND METHODS: Smoking habits and the presence of medical disease and prostate cancer in 1,034 patients who underwent transurethral prostatic resection were compared with fluid absorption levels. These levels were measured by the ethanol method and surgical blood loss, as determined by a photometer. RESULTS: The incidence of fluid absorption greater than 1,000 ml. was 15.7% in the present smokers, 15.5% in the past and present smokers, and 8.8% in those who had never smoked. Compared to nonsmokers, the relative risk of 1,000 to 2,000 ml. fluid absorbed in past and present smokers was 1.8 (95% confidence interval 1.1 to 2.9). The corresponding relative risk of absorption greater than 2,000 ml. was 2.1 (95% confidence interval 1.1 to 4.3), with the greatest excess risk in present smokers, which was 2.8 (1.3 to 5.9). These differences between smokers and nonsmokers were even greater in the healthiest patients, while being relatively smaller in those with medical disease or prostate cancer. Fluid absorption correlated with the amount of blood lost but the demonstrated association between smoking and fluid absorption (p <0.024) could not be explained by an effect on blood loss. CONCLUSIONS: Past and present smoking increases the risk of large scale fluid absorption during transurethral prostatic resection. A possible reason is that smoking alters vascular growth in the gland.

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PubMed2000

Transurethral microwave thermotherapy v transurethral resection of prostate.

Transurethral resection of the prostate (TURP) has been the gold standard for the treatment of symptomatic benign prostatic hyperplasia for three decades but is now being challenged by other approaches such as transurethral microwave thermotherapy (TUMT). Comparison of these techniques must consider the functional, financial, and social aspects of each procedure. Because of differences in equipment, it is difficult to draw valid conclusions from the comparisons of the functional results of TURP v TUMT, but the two appear equivalent in relieving symptoms, although TUMT appears slightly less effective in improving flow. Preliminary data suggest that TUMT is less expensive than TURP, but more data are needed. Although high-energy TUMT is not yet on a par with TURP, it is a valid alternative for many patients.

Health Care Costs↗

PubMed2000

[Significance of bacterial prostatic colonization for nosocomial urinary tract infections after transurethral prostate resection].

Nosocomial urinary tract infections (UTI) are frequent complications after transurethral prostatectomy. The resection itself, postoperative catheterization and the prostate are possible causes of these infections. In this prospective study we investigated the influence of bacterial prostatic colonization on the incidence of postoperative urinary tract infections and inflammatory complications. In 78 patients we observed in 42 cases (53.8%) a bacterial prostatitis. In 14 patients (17.9%) we found nosocomial UTI's and in 12 patients (15.4%) inflammatory complications. The incidence of postoperative UTI's increase significantly in patients with positive prostate-cultures. On the other hand we only found corresponding prostate- and postoperative urine-cultures in less than 50%. The presented data are not sufficient to conclude the kind of relevance of bacterial prostatic colonization for postoperative UTI's in transurethral prostatectomy. Under consideration of the significant increase of nosocomial UTI's in patients with positive prostate cultures a perioperative antibiotic prophylaxis seems to be required in general.

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PubMed1988

Radical retropubic prostatectomy after transurethral prostatic resection.

In 16 patients who underwent radical retropubic prostatectomy because of adenocarcinoma of the prostate after previous transurethral resection, the difficulty of the operation, the morbidity rate, and the survival time were evaluated. Eleven patients had tumours staged A2, 5 patients tumours staged B1. Duration of the operation and blood loss were almost similar to the group of patients who had not had prior transurethral resection of the prostate. The impotence rate was 100% due to difficulties preparing and preserving the neurovascular bundle. Only 1 patient had stress incontinence. One patient died after 2 years with rapid tumour progression, 1 patient shows local recurrence. Radical prostatectomy may be performed safely with an acceptable morbidity rate following transurethral resection of the prostate.

Adenocarcinoma↗